South Dakota Insurance: 2023 Coverage Guide

South Dakota Affordable Healthcare Insurance

People in South Dakota only have a couple of options for health insurance plans but they should still compare rates carefully. If you’re an individual or you’re buying coverage for a family, you can find the coverage you need at the best prices by comparing your options with SmartFinancial. Be sure to sign up for your new health plan during open enrollment or you may have to wait another year unless you are eligible for the Special Enrollment Period due to a qualifying event. 

When Is Open Enrollment in South Dakota?

November 1, 2022 – January 15, 2023

How to Get Health Insurance in South Dakota

It’s a good idea to have a projection of healthcare costs for the following year. You can estimate it based on the previous year. You’ll need this to decide which type of coverage is right for you, and which level tier suits your needs and will be most economical. Sometimes, higher premiums end up saving you money if you frequently visit care providers.

To get the best rates for the coverage you choose, compare health insurance companies and health insurance quotes. After you submit the form you’ll get several competing health insurance rates to choose from, and we’ll connect you with a trustworthy agent in your area so you can buy the coverage or ask questions about the plan you’re considering.

What Types of Health Insurance Are Available in South Dakota?

HMOs, EPOs, PPOs and POS plans are available in South Dakota. There are also five tiers to choose from when you select coverage: catastrophic, bronze, expanded bronze, silver and gold. The higher the metal tier, the higher the monthly premium.

Does Health Insurance Cover Pre-existing Conditions?

The Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

• Did you lose a job, change jobs or even start your own business? You qualify to buy health insurance outside the enrollment period.
• If you were on your parents’ health insurance plan you are no longer covered once you turn 26. But you can enroll in an individual health plan outside the enrollment period.
• If you had a health plan that was valid in one region or state but you moved to another outside the enrollment period, you can buy a new health plan.
• If you bought Cobra to extend your healthcare coverage and it reached the deadline, you can enroll in a new health plan.
• If you were married and shared a health plan with your spouse but you divorced, you can enroll in an individual health plan.
• If you recently married, you may be able to get added onto your spouse’s policy or start an entirely new one together.
• If you had a baby outside the open enrollment date, you can buy health insurance.
• If you were covered under your spouse or partner’s health plan but that person passed away, you qualify to enroll in an individual plan outside the open enrollment period.
• If you were on a partner or spouse’s health plan but lost coverage for any qualifying reason, you can buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in South Dakota?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in South Dakota?

The average cost of health insurance in South Dakota for a 40 year old is about $463 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in South Dakota

The best way to save on health insurance in South Dakota is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.

Medicare in South Dakota

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in South Dakota?

17% of the population of South Dakota are on Medicare.

How Much Is Medicare in South Dakota?

If you do not qualify for Medicare, you can buy it for $499 a month for Part A in 2022 and a standard monthly premium for Medicare Part B was $170.10, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government-subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2022, it was $7,550 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during the open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in South Dakota

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in South Dakota?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

South Dakota State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the South Dakota Health System are listed below:

• South Dakota: Overall Ranking: 29 of 51
• South Dakota: Overall Performance: Below U.S. Average
• South Dakota: Access and Affordability: 31
• South Dakota: Prevention and Treatment: 19
• South Dakota: Avoidable Hospital Use and Cost: 20
• South Dakota: Healthy Lives: 28
• South Dakota: Health Care Disparities: 29

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South Dakota Health Insurance Coverage

The people of South Dakota have different kinds of health insurance while some South Dakota residents are not insured at all. See the breakdown below:

• Private coverage: 55%
• Medicaid: 17%
• Medicare: 17%
• Uninsured: 11%

Report: America's Health Insurance Plans

South Dakota Health Insurance Companies

The following carriers offer health insurance and/or medicare in South Dakota.

• Avera
• Sanford